Family stress following traumatic brain injury (TBI) is well documented. Previous studies have shown that family adaptation and the use of coping strategies moderate the stresses of TBI in the long term. However, relatively little is known about the impact on the family and family response during the acute stage of recovery. The present study used Olson's Circumplex Model to examine acute changes in family structure and examined changes in coping responses pre- and post-TBI. Wives of 20 male TBI survivors completed the Couples Version of the Family Adaptability and Cohesion Evaluation Scales-II (FACES-II) and the Coping Responses Inventory (CRI). These questionnaires were completed retrospectively for a stressful event that occurred six months prior to the TBI, then for the current period following the TBI. Results found that 60% of all families experienced a significant change in structure following TBI. As predicted by the Circumplex Model, balanced families changed most, with 70% changing to the extreme type post-TBI. Focus of coping (problem versus emotion) and coping techniques (cognitive versus behavioral) also changed significantly from pre- to post-TBI and differed, depending on post-TBI family structure. Family interventions based on these differences in family structure and coping are presented.